Contralateral risk-reducing local therapy in breast cancer patients with BRCA1/2 mutations: systemic review and meta-analysis

• Main Authors: Ziqi Jia, Jiaxin Li, Yuelun Zhang, Xin Wang, Jiahua Xing, Zeyu Xing, Xin Huang, Gang Liu, Menglu Zhang, Kexin Feng, Jiang Wu, Wenyan Wang, Jie Wang, Jiaqi Liu, Xiang Wang
• Format: Article
• Language: English
• Published: BMC 2021-09-01
• Series: Cancer Cell International
• Subjects: BRCA1; BRCA2; Contralateral risk-reducing mastectomy; Contralateral prophylactic irradiation
• Online Access: https://doi.org/10.1186/s12935-021-02194-2

Abstract Background Unilateral breast cancer (UBC) patients with germline pathogenic BRCA1/2 variants have a higher risk of developing contralateral breast cancer (CBC) and need contralateral risk-reducing local treatments, including contralateral risk-reducing mastectomy (CRRM) and prophylactic irradiation (CPI). The aim of our study was to systematically explore the efficacy of CRRM and CPI in reducing CBC risk and increasing survival. Methods A search was done, and eligible randomized trials and cohort studies should include and compare UBC patients with germline pathogenic BRCA1/2 variants who have and have not received contralateral risk-reducing local treatment. Random-effects meta-analysis was used in this study. Primary outcomes of the studies included overall survival (OS) and the incidence of contralateral breast cancer (CBC), and secondary outcomes included breast cancer-specific survival (BCSS). Results A total of five studies with 1769 UBC patients with germline pathogenic BRCA1/2 variants were enrolled in our meta-analysis. CRRM was correlated with a lower risk of CBC in UBC patients with germline pathogenic BRCA1/2 variants (summary RR = 0.07; 95%CI 0.03–0.13, I2 = 3%), a significantly increased OS (summary RR, 1.15; 95%CI 1.04–1.26, I2 = 26%) and a significantly increased BCSS (summary RR, 1.18; 95%CI 1.07–1.31, I2 = 64%) compared with surveillance. CPI also decreased the risk of CBC (RR 0.02; 95%CI 0.05–0.88) but did not significantly improve OS (RR 0.97; 95%CI 0.90–1.05) and BCSS (RR 0.97; 95%CI 0.90–1.05) compared with surveillance. Conclusions CRRM reduces CBC risk and increases OS and BCSS in UBC patients with germline pathogenic BRCA1/2 variants, and could be offered as a risk-reducing local treatment. For those who oppose CRRM, CPI could be offered for CBC-risk reduction, while its survival benefit is still uncertain.